I sat down without really noticing, wrapping the blanket around me
as I slid to the end of the couch so that I could lean on the arm. I
remained motionless; the time I sat was endless. I didn't remember
when I sat down or how long I stayed there. There was no passing of
time; there was only infinite, wordless space. Flashes of scenes kept
rolling through my head like a slide show, and I couldn't make them
stop or change them. I was suffering terribly, but I couldn't stop
it or change its path. I sat for hours and days and weeks, trying to
make sense of the horrors I had encountered. The image of the
decapitated, dismembered bodies could not be erased from my memory. The
silver tray of heads left behind a constant reminder of the
victims' last moments of terror. Burned and blackened arms were
reaching out as if they wanted someone to pull them from the plane, an
image that joined forces with the others and haunted my nightmares.

This wasn't my first mass fatality; I had worked at others as
a disaster mental health professional, but this one was the most
intense. The heat was unbearable; it rained an inch a day and the
moisture hung in the air. My clothes were wet the moment I put them on,
and they stayed wet from sweat all day. The crash site was muddy and
steep. The area around the plane had burned and was clear of vegetation,
but jungle growth was thick around the perimeter. You didn't dare
reach out to grab at a plant if you slipped because the swordgrass would
tear open your hand like the blade of a knife.

[ILLUSTRATION OMITTED]

Young military personnel were swarming around trying to find body
fragments or personal effects. They had on full Kevlar (which is
plastic-coated and doesn't breathe), and their gloves were
duct-taped to their wrists. The work conditions were so difficult that
they worked for a short time and then were permitted to rest before they
went out again. As they picked up personal effects from the ground, one
of the men held up a baby shoe in a clear plastic bag, which threw me
entirely off-balance. That baby shoe did not belong in an evidence bag.

Nearly three weeks after the plane crashed, everything seemed to be
picked up. The workers "walked the grid" several times, and
the site was finished.

After the disaster site, I was assigned to the huge metal facility
being used for the plane crash victims' autopsies. The building was
open to the heat and the bugs, and when the rain came down sideways in a
torrent every afternoon, the rainwater ran into the facility on the
floor into big puddles. There were open cans of coffee placed on the
floor to try to mask the smell of decomposition, but nothing covers that
smell; it permeates everything. The bodies were laying on silver gurney
tables spread out in every direction. I was assigned to the morgue
workers as a mental health debriefer. As I walked my rounds through the
facility one day, I was distracted by movement on one of the silver
gurneys. It startled me, but I forced myself to walk closer to see what
was moving. I was horrified at what I saw: a mound of individual teeth
was given the illusion of movement by the thousands of flies crawling
around on the teeth at the same time.

One day at the end of my shift, I was drafted to debrief the local
folks who had first responded to the plane crash. The locals had heard
the noise of the crash and rushed to the site. They tried to pull the
few injured survivors out of the plane, but were unable to do much
before the ball of fire raced through the plane and killed anyone left
inside. The townfolk had requested debriefings, and I was one of those
asked to spend the evening providing them. I heard the stories about the
first hint of trouble, the sound of the crashing plane, the heat of the
fire ball, and the screams of the people who had survived the crash but
were killed by the fire.

After my time at the morgue was finished, I was assigned to the
families. I spent one full day at the outdoor memorial service. During
the day we had a Protestant service, a Catholic service, a Buddhist
service, and a shaman service. The heat continued and the air was full
of moisture, clothes were soaked in sweat, and it felt like trying to
breathe under water.

[ILLUSTRATION OMITTED]

I was then assigned to the hotel where the families of the plane
victims were staying. The grief in the building was palpable; you could
almost reach out and touch it. The weeping, moaning, and lamenting of
the family members and paid mourners was continuous. I visited with the
families of the plane crash victims and heard their stories of grief and
loss.

The large ballroom of the hotel was used as a chapel. Incense
constantly burned, filling the air with the smell of an overpowering
perfume. One wall was filled with framed 8x10 pictures of every victim
in the plane crash, about 200 total. One day, without realizing the
consequences of what I was doing, I found myself standing in front of
the wall of pictures. As I looked at the pictures of the victims, my
mind started making connections that I didn't intend to make.
Looking at the picture of the woman with grey hair, I started thinking
things like "I recognize that grey hair; it was on one of the heads
on the silver tray. Oh yes, and that curly hair, I remember seeing that
burned body. And that baby, that is the one they put in the tiny casket
and probably belonged to the little shoe I saw in the plastic bag. And
that one, her legs were burned off, and I recognize her from the family
picture her son and daughter showed me yesterday." At about that
point, I went and sat quietly in a corner, hunched my shoulders, and
tried to shut out what was going on around me.

I had worked the crash site, heard the stories of the crash, seen
the grotesque dead, lived with the daily smell of decomposition, and
visited with the grieving family members. I had an overall mental
picture, and it overwhelmed my ability to detach and protect myself. I
vaguely remember finishing my time on the job. I felt like an eggshell
with cracks all around it; I needed to hold it together long enough to
get home. I got on the plane to return to my home in the United States.
Then the flashbacks and nightmares started.

I wasn't sleeping. When I did sleep, I would wake up suddenly
in a cold sweat with pictures in my head that I didn't want there.
I would wander the halls of my house in the middle of the night,
checking on my children. Once I was awake, I didn't want to go back
to sleep, so in the dark quiet of the night I would spend time on the
computer trying to figure out what to do to help myself. I spent time
reading literature from trauma researchers. The studies that have been
done and the reviews of stories of people who had similar symptoms
helped me understand that I was not alone, which helped me to understand
that I was not weak or crazy. I knew intellectually what was happening;
after all, I am trained in mental health. Somehow, I had the belief that
my knowledge should have made me invulnerable to these symptoms.

I went to my mental health colleagues for help. They were concerned
and even told me they were afraid for me, but they gave me no hope. I
went to one counselor who, when I started to tell details, told me to
stop because she didn't want to hear them. I sat there thinking,
"But I need to tell them. I need someone to listen and
understand." Over a period of weeks I tried to tell my story to
anyone who would listen, but I left out details because I didn't
want to traumatize anyone else. I was sure the third counselor I went to
would be the one who would help me. He was trained as a psychologist and
was a member of the debriefing team. I spent an hour telling him my
story, trying to explain the heat, the bugs, the jungle, the smells, and
the sounds. I was exhausted at the end of the hour. He sat back in his
chair and told me my problem was that my identity was too wrapped up in
the agency I worked for. I was stunned. I told him he was full of it,
that he didn't know what he was talking about, and I walked out the
door. I just wanted him to say that I went through a horrible experience
and that I would get through it. I wanted him to give me hope. I started
dividing the world into those who "got it" and those who
didn't.

I went home and seriously considered taking my own life. My anger
was overwhelming, and I wanted to strike out and hurt someone. The depth
of despair that I had reached was frightening me. I couldn't
control the swings between the anger and the despair. But the worst of
it was the lack of hope. I did not want to die; I wanted to stop the
hurting inside of me. I wanted the nightmares and flashbacks to stop,
but I had no hope that they would. In the deepest part of my gut it felt
like it would always be this way and continuing to live like this was
unthinkable.

A Vietnam vet briefly entered my life and was the first to give me
a glimmer of hope. We sat in a restaurant while I cried and told him my
story. It has been a decade since that lunch, but it is still so clear
to me today. He reached across the table, patted my hand, and said,
"I made it through this and so will you." I grabbed on to that
promise, and I clung to it every day like a lifejacket that kept me from
drowning. Several months had passed since I had come home, and for the
first time, I had hope.

In the decade since my time at this disaster, I have been to crime
scenes, watched autopsies, and worked many more disasters around the
world. Nothing has ever affected me quite like this particular disaster,
and I have some observations about my response to it. My first
observation is the lack of preparation I had for the grotesque dead. I
believe that seeing pictures ahead of time would have helped immensely.
I was trying to file away what I saw into some type of mental file
drawer that didn't exist. Once I arrived at the incident and was
briefed, seeing pictures of what to expect at my work site would have
given me a context in which to put these images.

I understand there is controversy about having mental health
personnel in the same environment as the workers, and there has been
discussion about having them wait and talk to workers in a "clean
environment." I believe it is important for mental health personnel
to be in the same work environment as the workers. This way, the workers
don't have to spend time trying to make the debriefer understand
their environment because it is understood by both of them; this saves
time, energy, and provides an instant connection. Workers have said to
me, "How can you debrief us if you don't know what we are
doing?" Having done it for many years now, I agree. Also, workers
who have told me they would not normally come for a debriefing have come
to me because they know and trust me. That knowledge and trust is earned
at the worksite. I don't believe my trauma came from being with the
workers. In fact, that was a comfort. There was an understanding that
comes from shared surroundings. Even now, when I see one of those
workers at a disaster, I am recognized as someone who "gets
it."

I love my work as a disaster responder; it is immediate, intense,
and always challenging. I have the privilege of seeing people in their
finest altruistic moments. Being there to listen when disaster
survivors' grief or frustration overwhelms them allows me an
opportunity to provide them with a moment of healing. The work can be
emotionally draining and exhausting, but that does not mean it is
necessarily traumatizing. I believe my trauma was caused by my
involvement at every aspect of the scene--a kind of cross-contamination.
If I had just been at one or two of the locations, I believe I would not
have had the same response to the disaster. In fact, I have used this
knowledge to protect myself at disasters since that time. If I work with
first responders, I do not work with families. If I work with families,
I do not work at the disaster site or the morgue. This personal rule has
served me well, and I have worked disasters around the world for the
past decade without any trauma effects.

It is important for those of us who work disasters and have
responsibility for others to understand the consequences of our
assignments. We need to take a look at the way we prepare workers for
assignments. We are afraid of traumatizing them, so we don't share
the information that, in reality, protects them. I just wish that
someone had honestly shared information with me when I first started
this work, and I hope sharing this story will create an honest and open
dialogue about what is and is not helpful for disaster workers.

By Sandy Ramsey, MA, LPC, LMFT, FAPA

Sandy Ramsey, MA, LPC, LMFT, FAPA, is the President of Crisis
Recovery International (www.CrisisRecoveryInternational.org). She is a
Fellow of the American Psychotherapy Association, as well as a Fellow of
the American College of Forensic Examiners Institute. Sandy, a licensed
mental health therapist, took her first disaster mental health course in
1994 and has been responding to disasters ever since. She now responds
to disasters on a fulltime basis.